血糖变化幅度对危重症患者短期预后的影响  

The effect of the rangeability of blood glucose concentration on short-term prognosis in patients with critical illness

作　　者：卜彦斌[1] 吴子彬[1] 

机构地区：[1]河北省石家庄市第三医院重症监护病房,050011

出　　处：《河北医药》2012年第4期496-498,共3页Hebei Medical Journal

摘　　要：目的探讨血糖变化幅度对危重症患者短期预后的影响。方法回顾性分析在重症监护病房(ICU)至少监护3d且既往无糖尿病史的高血糖危重病患者280例的临床资料,监测患者在ICU期间的所有血糖值,记录入ICU时血糖浓度(GluAdm)、最高血糖浓度(GluMax)、平均血糖浓度(GluAve)、血糖变化幅度(GluSD)、血糖变异系数(GluCV)。按患者预后分为存活组(198例)与死亡组(82例),比较2组间GluAdm、GluMax、GluAve、GluSD、GluCV、严重低血糖发生率的差异,应用受试者工作特征曲线(RoC曲线)和logistic回归分析评价血糖变化幅度与预后的相关性。结果死亡组GluMax、GluAve、GluSD、GluCV、严重低血糖发生率均明显高于存活组(P<0.01)。GluSD、GluCV的ROC曲线下面积(AUC)明显高于Glu-Adm、GluAve的AUC(P<0.05)。GluSD、GluCV与预后显著相关(P<0.01)。结论 GluSD、GluCV升高与危重患者ICU病死率显著相关,较GluAve评价预后更准确;降低血糖变化幅度可能改善危重病患者的病情,是控制血糖的一个方面。Objective To investigate the effect of the rangeability of blood glucose concentration on short-term prognosis in patients with critical illness. Methods The clinical data of 280 critically ill patients with hyperglycemia, without diabetes mellitus history who were cared in ICU at least for 3 days were retrospectively analyzed, the patients ＇ blood glucose levels were monitored during ICU, and the blood glucose concentration on admission （ GluAdm）, maximum blood glucose concentration （ GluMax）, mean glucose concentration （GluAve）, variability of blood glucose concentration （ GluSD）, coefficient of glucose variability （GIuCV） were determined, The patients were divided into survival group （ n = 198 ） and death group （ n = 82） according to the patients＇ prognosis, and the differences of GluAdm, GluMax, GluAve, GluSD, GluCV and incidence of severe hypoglycemia were observed and compared between the two groups. The receiver operating characteristic curve （ ROC curve） and multivariate logistic regression analysis were used to evaluate the correlation between rangeability of blood glucose and patients＇ prognosis. Results The levels of GluMax, GluAve, GluSD, GluCV and incidence of severe hypoglycemia in death group were significantly higher than those in survival group （ P 〈0.01 ）. The area of GIuSD and GluCV （ AUC ） under ROC curve was 0.714 ± 0.033 and 0.701 ± 0.034, respectively, which was significantly higher than that of GluAdm and GluAve （0.512 ± 0.041 and 0.644 ± 0.037, P 〈 0.05 ） ,The multivariate logistic regression analysis showed that GluSD and GluCV were closely correlated with patients＇ prognosis （ P 〈 0.01 ）. Conclusion The increase of GluSD and GluCV is related with fatality rate in critically ill patients during ICU, which is more accuracy in evaluating patients＇ prognosis, as compared with GluAve ;To reduce rangeability of blood glucose may improve critically ill patients＇ condition, which plays certain role in controlling patients＇

关 键 词：危重病 血糖 血糖变化幅度 

分 类 号：R453[医药卫生—治疗学]